Insurance companies will have to mandatorily refund excess premium if the claim ratio turns out to be less than 85 percent under the Centre's ambitious 'National Health Protection Mission' (NHPM), says a proposal by the health ministry. The programme will provide a coverage of Rs 5 lakh to 10 crore poorest families of the country.
The proposal was discussed by the health ministry during consultations with representatives from leading general and stand alone health insurance companies, and private hospitals, yesterday.
Indu Bhushan, who took over as the chief executive officer of the ambitious Ayushman Bharat National Health Protection Mission (AB-NHPM) on May 1, while chairing the meeting, has sought the feedback of the insurance companies on the matter.
"We have proposed that the insurance companies will have to mandatorily refund the excess premium if the claim ratio turns out to be less than 85 percent under this project. This will ensure that insurance agencies do not have windfall gain from the ambitious scheme which aims at supporting the poorest 40 percent of the population for expenditure on health treatment," Bhushan told PTI.
For example, if the premium paid by the government is Rs 100, and the average claim per family is only Rs 50, the insurance company will refund Rs35 to the government, he explained.
Touted as the world's largest government-funded healthcare insurance programme, 'AB-NHPM' will provide a coverage of Rs 5 lakh per family annually and benefit more than 10 crore families belonging to the poor and vulnerable sections of the society.
The centrally-sponsored scheme will target deprived rural families and identified occupational category of urban workers' families, who constitute 8.03 crore in rural and 2.33 crore in urban areas, respectively, as per the latest Socio Economic and Caste Census (SECC) 2011 data, and will cover around 50 crore people.
The health ministry has prepared a detailed timeline to ensure completion of all steps to enable rolling out of the scheme anytime after July, while allocating around Rs 10,000 crore for the project.
In yesterday's consultation, representatives praised the initiative and the substantial engagement of all stakeholders covering aspects like operational guidelines, model tender document, empanelment criterion, package details and rates, etc.
“We need to design the scheme to ensure that the targeted beneficiaries get maximum benefits and we can expand access to quality health services in rural areas and Tier-2 and 3 cities. This can be done only when government, hospitals and insurance companies work together as partners," Bhushan said.